Meet AASLD Guidelines for Antiviral Therapy

[choppedliver]

I've looked at the AASLD's guideline for antiviral therapy for Hep B.  I'm wondering if my relative even needed to be on antirival medication.

At the time, the person had "non-reactive" (negative?) HBe Ag and "reactive" HBe Ab (positive?).  
HBV DNA count = 3,000 IU/mL [<100] and 5,700 copies/mL [<160].
ALT=43, AST=44.

At these levels, did the person meet the guidelines?  Are the DNA counts considered "high"?  For the liver enzymes, taking the midpoint of the normal ALT range is ~25.  So the ALT needs to be 50 to be "twice the normal level"?  Is this the way to measure it?

[stef2011]

it is better you ask lab to make conversion, you should mutiply by 5.8 but you don t get exact IU/ml because there is no exact correlation between the 2 assays

copies/ml has been cancell internationally from 2008/2009 and only old assays are still giving results in  copies/ml, ask lab to change unit in iu/ml for you

hbvdna is not the more important to choose if to start therapy, liver damage is the most important parameter any result lower than 7kpa no significant liver damage and any value higher than 9kpa severe fibrosis (11kpa best cutoff value for cirhosis although some still use 12,5kpa).cancer risk increases after 10kpa

after liver damage consider hbvdna and last alt level, choose immune modulators instead of nucs if liver damage is not severe since nucs are ofr life immune modulators like interferon and nitazoxanide make no resistance and can be stopped after 1-2years

[choppedliver]

Well, that's how I thought, too.  Multiply 3,000 by 5.7.  

But this particular blood work from QD says

3,000 IU/mL [<100]
5,700 copies/mL [<160].

What do <100 and <160 mean?  Are we going by the <100 or <160?

If <160, then, this we need to divide 5,700 by 5.7 and it's only 1,000 IU/mL.

[chanthou]

Hi,

To convert UI to copies you need to multiply by 5+ (between 5-6). So if you have 3,000UI it should be at least 15,000 copies, which is slightly high (but not high).  You should consult with more than 1 doctor whether treatment is needed, especially liver specialists. Don't rush.  Sometimes, at this level treatment is not compsulsory.

[stef2011]

i just wrote today US has not yet approved fibroscan, sorry i ment i just read today firbroscan........
i know it is expensive and made in france but it is almost 6 years old in clinical practice, if they use it so much instead of biopsy there must be a reason

[stef2011]

these are the old 2009 guidelines
http://www.easl.eu/assets/application/files/b73c0da3c52fa1d_file.pdf

there are updates in 2010 from the liver vienna conference in april 2010 but available to members only but in general i have reported them in the community.

i don t remember if the main from 2009 or 2010 are new alt levels and interferon, tenofovir and entecavir the only first line agents

[stef2011]

i just wrote today US has not yet approved fibroscan....sorry for US citizens but from europe and asia you look third world country as to health care

[stef2011]

AASLD's guideline for antiviral therapy for Hep B

aasld is not good, they make few updates to giudelines (i think they are still in 2008) and look much influenced by drug makers (the major industry in US).

since all relevant research is made in europe and there is musch less drug makers influence i suggest to check easl, they also update guidelines yearly or more according to the new discoveries without exposing patients to danger of resistance and old practise.
easl and apasl (asian liver association) has close collaboration with easl

www.easl.eu
http://www.easl.eu/_clinical-practice-guideline

you will find european guidelines make much more sense